Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate, and service, especially for low- and middle-income countries(LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime.

A global initiative was launched in 2016 by ICEC and CERN to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognized that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK, and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries. Read more…

Today’s global health challenges in underserved communities include the growing burden of cancer and other non-communicable diseases (NCDs); infectious diseases (IDs) with epidemic and pandemic potential such as COVID-19; and health effects from catastrophic ‘all hazards’ disasters including natural, industrial or terrorist incidents. Healthcare disparities in low-income and middle-income countries and in some rural areas in developed countries make it a challenge to mitigate these health, socioeconomic and political consequences on our globalised society. As with IDs, cancer requires rapid intervention and its effective medical management and prevention encompasses the other major NCDs. Furthermore, the technology and clinical capability for cancer care enables management of NCDs and IDs. Global health initiatives that call for action to address IDs and cancer often focus on each problem separately, or consider cancer care only a downstream investment to primary care, missing opportunities to leverage investments that could support broader capacity-building. From our experience in health disparities, disaster preparedness, government policy and healthcare systems we have initiated an approach we call flex-competence which emphasises a systems approach from the outset of program building that integrates investment among IDs, cancer, NCDs and disaster preparedness to improve overall healthcare for the local community. This approach builds on trusted partnerships, multi-level strategies and a healthcare infrastructure providing surge capacities to more rapidly respond to and manage a wide range of changing public health threats. Read the article…

 

Article: Coleman CN, Mansoura MK, Marinissen MJ, et al. Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer. BMJ Global Health 2020;5:e003252. doi:10.1136/ bmjgh-2020-003252

June 11, 2020

Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity (ITAR)

A new project, “Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity” (ITAR), supported by the Science and Technology Facilities Council (STFC), aims to design and develop new radiotherapy technologies to give more cancer patients in Sub-Saharan Africa access to treatment and to save lives. The project will contribute to the development of novel radiotherapy machines, specifically designed to meet the needs of African hospitals. The challenge brings together an international team of accelerator physicists and engineers, medical physicists, radiobiologists, radiation oncologists, radiologists, IT experts, and health system researchers.

The state of cancer care

The annual global incidence of cancer is projected to rise to 27.5 million cases by 2040, leading to more than 13 million deaths. Up to 70 percent of these will occur in low and middle-income countries (LMICs). Radiotherapy is an essential component of cancer care being a very effective means of curing the disease, as well as palliative treatment, and where available, is used to treat more than half of patients.

Many low and middle-income countries in Africa have acute shortages of radiotherapy machines. In the lowest-income countries, only four percent of cancer patients that need radiotherapy treatment are able to be treated. There are currently only 385 radiotherapy machines in the region, and 60 percent of those are located in just three countries – South Africa, Egypt and Morocco.

A report by the Lancet Oncology Commission – Global Task Force on Radiotherapy for Cancer Control (GTFRCC) of the Union for International Cancer Control (UICC) recently estimated that by 2035 at least 5,000 additional megavolt-class treatment machines would be needed to meet radiotherapy demands in low-and middle-income African countries.

A collaborative effort

The ITAR project, a critical part of a larger international project that includes the International Cancer Expert Corps (ICEC), CERN, STFC (Daresbury Laboratory), and Lancaster University, is led by Lancaster University and Oxford University and will bring together partners from the Cockcroft Institute, STFC’s Accelerator Science and Technology Centre (ASTeC), John Adams Institute, Swansea University, King’s College London, ICEC and CERN.

In ITAR’s first phase, the project will define the persistent shortfalls in basic infrastructure, equipment and specialist workforce which remain barriers to effective radiotherapy delivery, and develop novel solutions leading to a detailed specification and conceptual design. The project will then progress to a prototype development phase at STFC’s Daresbury Laboratory.

Professor Manjit Dosanjh, from CERN and Oxford University, and member of the ICEC Board of Directors, and who leads the overall international project, said: “I am really excited that the idea, first presented by Dr Norman Coleman of the International Cancer Expert Corps at the 2014 ICTR-PHE meeting held in Geneva, continues to flourish. Having Lancaster and Oxford Universities, along with Daresbury Laboratory and others working on this with STFC’s critical support and ICEC’s expertise, is a significant step in addressing the need for a novel medical linear particle accelerator to generate the radiation for LMICs and other challenging environments.”

Local stakeholder participation is vital to the project’s success

A critical aspect of the project’s challenge cluster is the involvement of the international partners. Dr. Taofeeq Ige and Dr. Simeon Aruah, of the National Hospital Abuja, Nigeria, and Dr. Surbhi Grover, of the Botswana-UPENN Partnership and Princess Marina Hospital, are key partners working in African hospitals. They will gather information from a network of other hospitals in Botswana, Ghana, Kenya, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe and play a key role in the definition of the specification for the new machines.

In addition, ICEC provides a network of international oncologists, medical physicists, and engineers working in radiotherapy systems. They are already providing training and mentorship in lower- and middle-income countries and will continue with their assistance in the development of the radiotherapy system in this project.

Professor Graeme Burt, of Lancaster University and the Cockcroft Institute, and who is leading the phase 1 project said: “Current radiotherapy machines are optimised for use in western countries. The ITAR project aims to design specifically for use in Africa making it far more tolerant to the local environment, which will greatly increase the capacity for more lives to be saved.”

Professor Deepa Angal-Kalinin, of STFC and the Cockcroft Institute, University of Manchester, and who is leading the accelerator design said: “I am keen to apply the knowledge and expertise at Daresbury Laboratory to develop a novel medical linac design in this phase of the project which will prepare us to build a prototype to test our novel ideas.”

Media queries should be sent to:
nina.wendling@iceccancer.org or graeme.burt@cockcroft.ac.uk